Donor-Specific Antibodies and Primary Graft Failure in Allogeneic Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis

Authors

Yiyu Xie, National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Yale New Haven Health/Bridgeport Hospital, Bridgeport, Connecticut.
Jay Parekh, Yale New Haven Health/Bridgeport Hospital, Bridgeport, Connecticut.
Zaixiang Tang, Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China.
Depei Wu, National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China. Electronic address: wudepei@suda.edu.cn.
Xiaojin Wu, National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China. Electronic address: wuxiaojin@suda.edu.cn.

Document Type

Article

Publication Title

Transplantation and cellular therapy

Abstract

With the increasing number of non-matched donor hematopoietic stem cell transplantations (HSCTs) has come increasing evidence regarding factors affecting graft outcomes. One factor affecting graft outcomes currently being evaluated is anti-HLA donor-specific antibodies (DSAs). In this, we analyzed the clinical relevance of anti-HLA DSAs in patients who have undergone HSCT at a population level by conducting a systematic review of existing literature. A comprehensive search was conducted through PubMed, Embase, the Cochrane library, and Web of Science from inception to January 1, 2021. A meta-analysis was performed of the association between anti-HLA DSAs and primary graft failure (PGF) with further subgroup analyses. The search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 920 eligible citations were identified, out of which 15 studies were included in the final meta-analyses after application of rigorous selection criteria and independent review. A total of 2436 patients were included in these 15 studies. Patients with anti-HLA DSAs prior to undergoing HSCT had a 7.47-fold increased risk of PGF failure compared with patients without anti-HLA DSAs (odds ratio, 7.47; 95% confidence interval, 4.54 to 12.28, P < .001; I= 28.91%, P = .1315). In subgroup and meta-regression analyses, area, Newcastle Ottawa Scale score, mean fluorescence intensity cutoff, primary disease, HSCT type, graft source, and pretransplantation desensitization did not affect the impact of anti-HLA DSAs on PGF. There also was no significant difference in impact between HLA class I and II on PGF. We conclude that the prior presence of anti-HLA DSAs has a negative impact on graft outcomes in recipients of haploidentical and umbilical cord blood HSCT.

First Page

687.e1

Last Page

687.e7

DOI

10.1016/j.jtct.2021.04.030

Publication Date

8-1-2021

Recommended Citation

Xie, Yiyu; Parekh, Jay; Tang, Zaixiang; Wu, Depei; and Wu, Xiaojin, "Donor-Specific Antibodies and Primary Graft Failure in Allogeneic Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis" (2021). Internal Medicine. 180.
https://scholar.bridgeporthospital.org/internal_medicine/180

Identifier

33989833 (pubmed); 10.1016/j.jtct.2021.04.030 (doi); S2666-6367(21)00890-3 (pii)